Empyema
Conditions
Keywords
thoracoscopy, fibrinolysis, empyema, children
Brief summary
The null hypothesis is that patients receiving either thoracoscopy or fibrinolysis for empyema recover in the same amount of time. Therefore, we will test this by randomizing the next 40 patients who consent to the study to one treatment or the other.
Detailed description
This will be a single institution, prospective, randomized clinical trial involving patients who are found to have at least a single septation within a pleural effusion as diagnosed by ultrasound or computed tomography. Additionally, patients with a pleural effusion wherein a pleural tap reveals pus as defined by many (\> 10,000/mm3 ) white blood cells or positive cultures will be considered. This is intended to be a definitive study. Power calculations based on the known 4.8 post intervention hospital days after VATS and the estimated 7 post intervention days after fibrinolysis with α = 0.05 and power of 0.8 show the need for 18 patients in each arm. We will intend to recruit 40. This sample size was constructed in consultation with Dr. Steve Simon, and the range of hospital stay in our retrospective experience was utilized. Therefore, this number should represent an adequate power in spite of the known varied level of illness. One group will undergo thoracoscopy to clean the pleural space and leave a chest tube postoperatively to drainage. The other group will undergo chest tube placement with subsequent infusion of fibrinolytics to dissolve the thick purulent material allowing drainage. Both groups will have the same antibiotic regimen with the same management algorithm.
Interventions
PROCEDUREChest tube with tPA infusion for 3 days
fibrinolysis through the chest tube
PROCEDUREVATS decortication
thoracoscopic decortication
Sponsors
Children's Mercy Hospital Kansas City
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
No minimum to 18 Years
Healthy volunteers
No
Inclusion criteria
* Patients less than 18 years of age requiring an intervention for empyema by one of the following: 1. Septation or loculation seen on ultrasound or computed tomography 2. Many white blood cells, bacteria present, or thick viscid purulence identified on pleural tap
Exclusion criteria
1. Immunodeficiency process 2. Secondary diagnosis or condition that will keep them in the hospital beyond the empyema 3. Existing contraindications to VATS or chest tube.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Length of hospitalization after intervention | 1 month |
Secondary
| Measure | Time frame |
|---|---|
| Days where a maximum temperature was equal to or above 38 degrees C, days of tube drainage, doses of analgesia and days of oxygen requirement, hospital days after intervention, hospital charges after intervention and procedure charges | 1 month |
Countries
United States
Outcome results
None listed